Double-blind randomized trial of buprenorphine and methadone in opiate dependence

This study compared the safety and efficacy of sublingual buprenorphine tab lets with oral methadone in a population of opioid-dependent individuals in a double-blind, randomized, 6-week trial using a flexible dosing procedure . Fifty-eight patients seeking treatment for opioid dependence were recruit ed in three outpatient facilities and randomly assigned to substitution wit h buprenorphine or methadone. The retention rate was significantly better i n the methadone maintained group (90 vs. 56%; P < 0.001). Subjects completi ng the study in both the treatment groups had similar proportions of opioid positive urine samples (buprenorphine 62%; methadone 59%) and positive uri ne specimens, as well Its mean heroin craving scores decreased significantl y over time (P = 0.035 and P < 0.001). The proportion of cocaine-positive t oxicology results did not differ between groups. At week six mean stabiliza tion doses were 10.5 mg per day for the sublingual buprenorphine tablet, an d 69.8 mg per day for methadone. respectively. Patient performance during m aintenance was similar in both the groups. The high attrition rate in the b uprenorphine group during the induction phase might reflect inadequate indu ction doses. Thus, buprenorphine is a viable alternative for methadone in s hort-term maintenance treatment for heroin dependence if treatment inductio n is done with adequate dosages. (C) 2001 Elsevier Science Ireland Ltd. All rights reserved.